Provider Demographics
NPI:1689281867
Name:GOODRUM MEDICAL SERVICES LLC
Entity Type:Organization
Organization Name:GOODRUM MEDICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODRUM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:727-350-4609
Mailing Address - Street 1:2280 OLD HIGHWAY 99 S
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-8738
Mailing Address - Country:US
Mailing Address - Phone:727-350-4609
Mailing Address - Fax:
Practice Address - Street 1:1806 ASHLAND ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-2331
Practice Address - Country:US
Practice Address - Phone:724-350-4609
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-30
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty